VA58 Campaign: Communities of Practice Sign-Up Form (Cohorts 2-10)

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VIEW CALENDAR OF COHORT MEETING DATES AT THIS LINK: https://bit.ly/va58-calendar

ROLLING & OPEN DEADLINE FOR COHORTS 5-10 UNTIL SPACE IS FILLED!
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***SEE COHORTS BELOW: REGISTRATION OPEN - UNTIL FILLED***

Cohort 5 - Rural Communities
Cohort 6 - Older Adults
Cohort 7 - People with Disabilities
Cohort 8 - Pacific Islanders
Cohort 9 - LGBTQI+
Cohort 10 - Asian Americans
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The Communities of Practice will be conducted via Zoom and participants will need internet access to participate. Our team can provide accommodations if participants are interested but do not have internet access. Additionally, we are able to conduct circles in other languages and can provide additional accommodations for the Circles with advance notice.

If you or your community leaders participating require non-English language support or other accommodations, we ask that you contact Maikhou Thao at maikhou@everydayimpactconsulting.com.

Thank you for your interest!

Email *

Full Name (First & Last) *

Pronouns *

Email Address *

Phone Number *

Organization/Affiliation *

Your County *

In the space below, please add any other ways you identify.

Please select ONE Cohort below. (Your answer should be the community group in which you identify). *

Cohort 1 - Black/African American [REGISTRATION CLOSED]

Cohort 2 - Latinx Group 1 (Spanish speaking Circle) [REGISTRATION CLOSED]

Cohort 3 - Immigrants/Refugees [REGISTRATION CLOSED]

Cohort 4 - Latinx Group 2 (English speaking Circle) [REGISTRATION CLOSED]

Cohort 5 - Rural

Cohort 6 - Older Adults

Cohort 7 - People with Disabilities

Cohort 8 - Pacific Islander

Cohort 9 - LGBTQI+

Cohort 10 - Asian American

Are you able to participate and attend ALL 6 sessions for your selected Cohort dates/times? Refer to this calendar link here: https://bit.ly/va58-calendar *

Yes

Please indicate YES or NO if you will need accommodations for internet access. (If YES, please explain in the space below). *

Please indicate YES or NO if you will need non-English language accommodations. (If YES, please explain and add the specific language(s) in the space below). *

Please indicate YES or NO if you will need additional accommodations not listed above. (If YES, please explain in the space below and a team member will be in touch with you). *

Any additional comments/questions for us?

A copy of your responses will be emailed to the address you provided.

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